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LIST SYSTEM. RETROFIT OR REPAIR„ <br />(Submit minimum of,3 sets of plans &applications as originals will be retained by EHD) <br />1. 'Site map .enol®sed? & YES [ lNQ <br />,K <br />Z.' Submit. copies' of ICC Service Technician and/or Installer's certificate and alt manufacturer training c�ertiflcates'for each, <br />person installing or testing;any component.thatis repaired or replaced. Ensure a,copy of the "Site Health and Safety <br />:Pian"• is available on the. jobsite as;required ;by Title 8. <br />3. t Detailed description of work to be completed. List components to be' repaired ®t replaced and attach a diagram drawn' <br />to scale showing location"of repairs and/oueplacements. If repairing a component, describe, how this will be done. (if <br />a din �piping��UDC's, or other UST equipment, or performing tank top upgrade, use the UST Installation Application <br />pages 4-8 as necessary,for a timely plan review): <br />®r S ,ncil,AIQ Loput Module A Transfarmw a ft EO VER SPIKE damage <br />QOLDSTARTED ang�ghecked ,peration <br />4. List of equipment to be used (Attach manufacturer's specification sheets showing third-party approval): <br />3311 9Q-001, u+ Module <br />�3Q734-001 • Power SuFgly <br />329338-001 • Power Supoly Transformer <br />a <br />2 <br />